Form NC-F-100 Registration Form

0607-XXXX

Expiration Date: XX-XX-XXXX

NC-F-100

Registration Form: 2020 Census New Construction Program Please complete this form and return it to the U.S. Census Bureau by email at GEO.2020.NC@census.gov or by using the provided prepaid envelope.							Entity ID:
							Entity Name:
Participation Information (Please select option 1 or option 2)
 YES, our government would like to participate in the New Construction Program (Select one method of participation for reference only and complete Sections B. and C.).  We will download the Geographic Update Partnership Software (GUPS) or Partnership Shapefiles (for use with our own Geographic Information System (GIS) from the website).  We will use Reference shapefiles provided by the Census Bureau (including GUPS program disc for users without GIS software on CD/DVD).  We will use Reference PDF Maps on CD/DVD. 2.  NO, our government is not participating. (Check the box below if another government is responding on your behalf and complete Section B.).
 Another government is participating on our behalf. (Please print government name):______________________________________
B. Official Responding to the New Construction Program Invitation (Please print)
Name of Official - (First, Middle initial, Last)
Signature of Official
Position/Title - (e.g. Commissioner, Mayor, Supervisor, etc.)
Telephone Number		Email Address				Date (mm/dd/yyyy)
Liaison Information Please designate your official New Construction Program liaison (work contact) by providing the following information. (Please print)
Name (First, Middle initial, Last)
Position/Title (e.g. Director, Assessor, Planner, etc.)
Telephone Number	Fax Number			Email Address
Department, Organization, or Agency Name (e.g. Planning and Zoning, Regional Planning Agency; please do not abbreviate)
Mailing Address (Number and Street name)
City			State		Zip Code
Delivery Address (House number and Street name; the Census Bureau will ship all materials via FedEx. FedEx will not deliver to P.O. Box numbers or P.O. ZIP Codes.)
City	State				Zip Code

We estimate that completing this program will take a total of 48 hours on average. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to GEO.2020.NC@census.gov. This collection has been approved by the Office of Management and Budget (OMB). The eight digit OMB approval number that appears at the upper left of the letter confirms this approval. If this number were not displayed, we could not conduct this survey. The Census Bureau conducts this program under the legal authority of the Title 13 U.S. Code, Section 141 (a). The Census Bureau is not permitted to publicly release your responses in a way that could identify your business, organization, or institution. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.

NC-F-100

U.S. Department of Commerce

U.S. Census Bureau